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Erschienen in:

25.09.2023 | Pancreatic Tumors

Bovine Pericardial Graft for Portomesenteric Reconstruction During Robotic Pancreatoduodenectomy

verfasst von: Marcel Autran C. Machado, MD, FACS, Bruno V. Mattos, MD, Murillo Macedo Lobo Filho, MD, Augusto C. Carvalho, MD, Fabio Makdissi, MD

Erschienen in: Annals of Surgical Oncology | Ausgabe 13/2023

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Abstract

Background

Minimally invasive pancreatoduodenectomy (PD) is one of the most complex procedures in oncologic surgery. We present a video of robotic portomesenteric reconstruction with bovine pericardial graft during PD.

Methods

A 52-year-old woman was referred with a mass in the head of the pancreas. The tumor was in contact with the portomesenteric axis. The multidisciplinary team decided to perform an upfront resection. The surgery was performed as a pylorus-preserving pancreaticoduodenectomy with lymphadenectomy. The superior mesenteric artery first approach was used to expose the head of the pancreas, so that the entire surgical specimen was attached only through the tumor invasion of the portomesenteric axis. After resection of the invaded portomesenteric axis, its large extension precluded primary reconstruction, so a bovine pericardial graft was used for venous reconstruction. After completion of the venous anastomosis, reconstruction of the digestive tract was performed as usual.

Results

Surgical time was 430 min; clamp time was 55 min; and portomesenteric reconstruction took 41 min. Estimated blood loss was 320 mL without transfusion. Pathology confirmed T3N1 ductal adenocarcinoma with free margins. No pancreatic or biliary fistula was observed, and she was discharged on postoperative day 8. A postoperative examination confirmed the patency of the graft. The patient is doing well 6 months after surgery and has no signs of the disease.

Conclusions

A bovine pericardial graft is useful for reconstruction and readily available, eliminating the need to harvest an autologous vein or use synthetic grafts. This procedure can be safely performed with the robotic platform.
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Metadaten
Titel
Bovine Pericardial Graft for Portomesenteric Reconstruction During Robotic Pancreatoduodenectomy
verfasst von
Marcel Autran C. Machado, MD, FACS
Bruno V. Mattos, MD
Murillo Macedo Lobo Filho, MD
Augusto C. Carvalho, MD
Fabio Makdissi, MD
Publikationsdatum
25.09.2023
Verlag
Springer International Publishing
Erschienen in
Annals of Surgical Oncology / Ausgabe 13/2023
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-023-14293-7

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